MEASURE 67: MEDICAL MARIJUANA SPLINTERS DOCTORS

Some Oregon Physicians Support Measure 67, Which Would Legalize The
Drug For A Variety Of Ailments, But Others Are Concerned About Its
Effects

The question of whether to legalize marijuana for medical purposes has
divided Oregon's doctors.

Some laud marijuana as a cheap, effective way to reduce the nausea and
pain of serious illness. Others warn that it's untested, unnecessary
and open to abuse.

The disagreement is so deep and widespread that the Oregon Medical
Association's governing body voted in April to remain neutral on the
issue -- neither supporting nor opposing Measure 67, which would make
smoked marijuana legal for a variety of medical purposes.

Doctors are drawn by sympathy for patients and the desire for their
methods to be scientifically valid, said Dr. Charles Hofmann,
president of the OMA, which represents 5,800 of the state's 8,300 physicians.

During its April meeting, Hofmann proposed adoption of the American
Medical Association's view on medical marijuana -- in essence, that
more research is needed before doctors give patients the drug.

The outcome of the debate was a replay of one in 1994, when the OMA
decided to take no position on physician-assisted suicide, another
contentious medical issue that went before Oregon voters. In both
instances, the state organization was at odds with the national
association, which strongly opposes assisted suicide and medical marijuana.

"Those two issues are so similar," Hofmann said. "The overwhelming
arguments in both are compassion and respect for individual rights."

He characterized the attitudes of Oregon doctors as a reflection of
people in general. A recent poll indicated that almost 60 percent of
Oregon voters would cast ballots in favor of Measure 67. The measure,
on the Nov. 3 ballot, would legalize marijuana for patients with
cancer, glaucoma, HIV/AIDS, seizures and muscle spasms, pain, nausea
and wasting.

Hofmann, a Baker City internist, opposes legalization. "I am concerned
that the amount of controlled scientific evidence that says smoked
marijuana is better for these specific conditions is lacking," he
said. "I fully believe that it is a step down the road to the
legalization of other drugs."

Dr. Richard Bayer disagrees. Bayer, a Portland internist and a chief
petitioner for the medical marijuana initiative, said he has seen
numerous patients who have benefited from smoking marijuana.

One of his patients, he said, had lost both legs to a land mine in
Vietnam and suffered the phantom pains that plague many amputees. "He
had morphine, but he said he liked marijuana better because it didn't
give him the hallucinations and constipation of morphine," Bayer said.

Bayer said he considered suggesting other patients try marijuana, "but
I never engaged in that discussion because I was too frightened that I
might lose my medical license."

When California voters approved legalization of medical marijuana in
1996, Bayer became involved in trying to make the drug available to
Oregonians.

However, few doctors have publically aligned themselves with him,
despite the OMA's lack of opposition. "Most are afraid to come out of
the closet because of fears about the DEA," Bayer said of the Drug
Enforcement Administration. Physicians who recommend marijuana fear
the DEA will revoke their permits to prescribe drugs.

Harbinger or harmless?

Some doctors say the medical arsenal has enough drugs against pain and
nausea without including marijuana.

Dr. Marshall D. Bedder, a pain management specialist with Advanced
Pain Management Group, a Portland physicians' group, said modern drugs
eliminate the need for smoked marijuana.

Bedder, whose practice includes treating drug addicts, sees medical
marijuana as another slip down the slope of drug abuse.

"Addicts uniformly tell us that marijuana was a gateway drug," he
said. "We have such a problem with substance abuse that to legalize
yet another substance is the absolute wrong direction to go.
Physicians now have the availability of the active ingredient in
marijuana -- THC -- that we prescribe every day."

Other doctors see marijuana as a relatively harmless substance. Dr.
Charles M. Grossman, a Portland internist since 1950, said that, on
balance, the medical marijuana measure "is something that is worth
passing."

In 1972, Grossman was chairman of a City Club of Portland committee
that considered the issue of decriminalizing possession of small
amounts of marijuana. Grossman said he searched medical literature for
evidence of marijuana's ill effects. "All the scientific literature I
read indicated that the effects of marijuana on people -- even young
people who smoked a number of joints a day -- was far less harmful
than alcohol and tobacco," he said.

Compassion for patients outweighs concerns about the possible side
effects of medical marijuana, Grossman said.

He acknowledged that the U.S. Food and Drug Administration hasn't
confirmed the safety and effectiveness of smoked marijuana. But FDA
approval is a secondary matter, he said. "You can't argue with
patients who say they get relief from their pain or nausea."

Concerns about lack of control

Dr. Susan McCall, vice president of the Oregon Society of Addiction
Medicine, a doctors' group, said the society opposes the measure, and
she sees many hidden pitfalls. "The initiative circumvents the normal
drug-approval process," she said.

Unlike other drugs, she said, marijuana's safety and effectiveness
would be enshrined in law. If science later found that marijuana was
harmful for some patients, there would be no way, short of legislative
action, to force its withdrawal from use, she said.

A big drawback of the measure, she said, is that it does not provide
for the kind of evaluations that, for example, caused the wildly
popular diet drug Redux to be taken out of circulation in September
1997. Redux was taken off the market by the FDA when it was found to
be associated with heart-valve abnormalities.

McCall also said the measure would prohibit the Oregon Board of
Medical Examiners, the licensing board for physicians, or anyone else
from overseeing a physician's recommendations for marijuana use.

"The recommending physician would be the only one eligible to review
it," she said. "There's no requirement for that physician to be
skilled in the treatment of the condition for which it's recommended.
You may have it recommended for treatment of (multiple sclerosis, for
example), but the physician could be a psychiatrist."

Before using a drug that might have undesirable side effects, she
said, doctors should ask whether all traditional medications have been
tried.

"We do encourage the study of the potential impact of making cannabis
available for medical use," she said. "We support the legitimate use
of delta-9-tetrahydrocannabinol." That substance, a derivative of
marijuana, is used in Marinol, a prescription drug used for nausea.

Dr. Grant Higginson, Oregon health officer and deputy administrator of
the state Health Division, prepared a fiscal impact statement
estimating that about 500 Oregonians would use marijuana annually if
the measure passes. He estimated it would cost $140,000 to $295,000
annually to fulfill the agency's responsibilities under the law.

Checked-by: Patrick Henry